Fig. 10.8 Carboxytherapy session showing localized and temporary bulging eyelid

skin. For the delicate skin of the eyelids, a selected flow of 20 ml/min is adequate, while flows as high as 150 ml/min may be used in other areas. It is important to warn patients that the treated area will bulge slightly due to the insufflation (Fig. 10.8), but that this is temporary.

One session of carboxytherapy may take 10–15 min and there is no need for a recovery period. Carboxytherapy may be performed in combination with other skin rejuvenation techniques. Results are most typically seen after the fifth session. In eyelids, for example, improved skin texture, color, and reduction in prolapsed fat pads may be seen. As well as the face, the neck, chest, and arms can be treated. In combination with techniques such as the CromoPeel or Dermaroller, excellent results may also be achieved in improving striae [21].

10.4 Complications

Due to the noninvasive and non-ablative nature of these techniques, if correctly performed, the risk of complication is minimal. With the local skin treatment, it is important to adequately teach patients how to apply the topical agents and to avoid mixing their prescription with any others agents. Strict avoidance of sun exposure during the treatment is required. If the instructions are not correctly followed, either a suboptimal result or indeed no result will occur. In addition, skin irritation or a burning sensation may be experienced.

With the Friendly Peel, which is an extremely safe agent, very few side effects have been witnessed. This treatment can be safely carried out in all skin types,

including very sensitive skins. I have personally never seen a case of PIH. This light chemical peel can be done in combination with microdermabrasion. A few patients may experience mild swelling of the face or a slight subjective yellow tinge to the face, which are temporary.

With microdermabrasion, it is important not to exert excessive pressure on the face and to perform regular movements of the handpiece, in order to avoid irregular patterns, skin damage, and the possibility for PIH development.

Dermatologic Carbon Dioxide Infusion is a highly useful procedure, if properly done. Some patients may develop ecchymosis and temporary bulging, especially on the eyelids.

10.5 Discussion

In order to achieve the best results, some type of local treatment is mandatory. There are numerous agents on the market which promise skin improvement and rejuvenation; however, most of them will not work. Unfortunately, many of these will cause skin sensitivity. I consider tretinoin to be the best agent in terms of skin conditioning and skin rejuvenation. It is also very useful in cases of acne and can be used in all skin types. Its side effects are temporary and can be minimized if the patient understands how to use it and if treatment starts gradually.

The Light Chemical Peel or “Friendly Peel” is used when the skin requires more than a home treatment. It stimulates the skin in a mild manner, hence its name “Friendly.” Microdermabrasion can produce epidermal and dermal improvement by outer layer stimulation. In cases where thicker skin, oily skin, or acne skin is present, or in cases where skin needs stronger action, the combination of microdermabrasion and Friendly Peel is excellent. Dermatologic CO2 infusion is an old technique that has reappeared recently and has an important role when the eye lids, face, and neck require skin improvement.

10.6 Conclusions

Together, Cosmetic/Plastic Surgery and Dermatology play important roles in helping patients achieve their goals of facial rejuvenation. These specialities must

work together in order to complement one another. Most surgery will achieve a better result if the skin is properly treated. On the other hand, in many cases, skin treatment alone will not achieve the ultimate goal of face rejuvenation. We see excellent results and patients are highly satisfied when the medical plan and the surgical plan are clearly explained. This avoids misinterpretations and facilitates patient compliance, leading to the best possible results for facial rejuvenation.

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